"According to the IRS [Chief Counsel Memorandum], it is not only these unsubstantiated expenses that are taxable. If expenses are not properly substantiated, then the employer's cafeteria plan is invalid. In other words, all deductions for medical insurance premiums, FSAs, and any other items would be treated as taxable compensation to the employees. All FSA reimbursements would be taxable as well."  MORE >>

"[C]hanges for 2022 reporting [may] require some quick pivots to ensure the plan is on track to meet its reporting obligations.... [P]lan sponsors that may have missed vendor deadlines that would permit the vendor to complete the required reporting on the plan's behalf should put together an action plan to submit the required data by June 1, 2023 -- as of now, there is no extension of this deadline and no relief that would excuse the plan's non-compliance."  MORE >>

"[1] Modified deadlines ... [1] Qualifying event notice ... [3] Sending COBRA election notices ... [4] COBRA election period ... [5] First COBRA payment due date ... [6] COBRA payment due date ... [7] Claim filing deadline ... [8] Internal appeal deadline ... [9] External appeal deadline ... [10] Special enrollment ... [11] Plan sponsor/administrator considerations ... [12] Document changes."  MORE >>

"[It] is the DOL's position that FAQs Part 58 announced the end of the National Emergency as July 10, 2023.... [G]roup health plans and issuers (i.e., insurers) are either required or 'encouraged' to provide notice of COVID-19-related benefits coverage changes to plan participants, and in some cases beneficiaries and other enrollees ... [T]he Outbreak Period deadline extensions ... will cease to apply effective 60 days after the end of the National Emergency.... [T]he Departments note that nothing prevents a plan or issuer from permitting longer timeframes to provide notices and elections under these provisions and plans are encouraged to do so."  MORE >>

"[E]mployers that sponsor health and welfare plans are still permitted to provide coverage for preventive services without participant cost sharing. The decision -- even if it stands -- only implicates the requirement (not the ability) of employer group health plans and insurers to provide this coverage.... [M]ost group health plan sponsors will be unlikely to scale back coverage for preventive services in any meaningful way."  MORE >>

"The end of the PHE ... will have effects beyond lowering paid leave requirements.... [B]ecause leave requirements are reduced, employers that could not satisfy their HFWA obligations through a general paid time off policy during the PHE may be able to now.... [E]mployers can now ask for reasonable documentation for HFWA leave requests without fear that they are violating the law."  MORE >>

"The Seventh Circuit also reasoned that ... the Severance Plan makes the receipt of severance benefits contingent on receipt of the HR Memo. Severance benefits do not vest like retirement benefits and employers may design these plans in their own interests. The Severance Plan gives the HR department discretion to decide who gets the HR Memo." [Carlson v. Northrop Grumman Severance Plan & Northrop Grumman Corp., No. 22-1764 (7th Cir. May 8, 2023)]  MORE >>

"Narrow networks are designed to provide cost effective access to providers with proven clinical outcomes. But not all healthcare facilities provide the level of quality necessary to make a narrow network viable for your employees. ... [1] Demographic fit  ... [2] Geographic fit ... [3] Financial fit ... [4] Cultural fit."  MORE >>

"Though the vast majority of people with private health coverage will continue to have coverage for COVID-19 tests ordered or administered by a clinician, those tests may soon be subject to cost sharing, quantity limits, and prior authorization requirements.... [T]he median price of a COVID-19 test in an outpatient clinical setting was $45 in 2021 among people with large employer-based health coverage ... [T]he median discounted hospital-based self-pay rate was $51 for a COVID-19 antigen test and $91 for a PCR test.... [R]ecent prices for at-home rapid COVID-19 tests average about $11 per test."  MORE >>

"[T]his report: [1] provides an overview of the current coverage and payment of COVID-19 vaccines and treatments across payers; [2] identifies expected gaps in coverage after the end of U.S. Government-provided supply and key considerations for coverage determinations post-PHE; and [3] presents estimates on expected savings and spending offsets for a select set of COVID-19 products that have been demonstrated to reduce COVID-19-related hospitalizations." [Updated May 2023]  MORE >>

"The past decade has seen a lot of talk about value-based payments, accountable care organizations (ACOs), bundles, capitation, and the like. However, compared to the rhetoric, implementation has been plodding. But the fusing of payers and providers across the US health care system finally seems to be at a critical inflection point and will drive expansion of [alternative payment methods]."  MORE >>